Strategies for clinical and public health management of sexually transmitted infections

This thesis reports on four different research topics at a sexually transmitted infections (STI) clinic: 1) evaluation of diagnostic tests, 2) clinical management, 3) public health surveillance, and 4) public health interventions. Three commercially available type-discriminating herpes simplex virus (HSV) antibody tests were evaluated in sera from patients with a recurrent genital HSV-1 or a recurrent genital HSV-2 episode. Also, the use of Gram-stained urethral smears to test for urogenital chlamydia was assessed. The prevalence, spontaneous clearance, and genotypes of pharyngeal C. trachomatis among STI clinic patients were examined. To find potential evidence for the possibility of LGV transmission from the urethra to the rectum, the positivity rate for urogenital LGV was established in a selection of men who have sex with men (MSM). Another study assessed the community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) prevalence in MSM at the Amsterdam STI clinic. STI testing outcomes among three different populations at the Amsterdam STI clinic are evaluated. First the yield of hepatitis C screening in HIV-positive MSM and MSM opting-out of HIV testing is discussed. Next, the outcomes of STI screening in MSM requesting post-exposure prophylaxis (PEP) for HIV and finally, in victims of a sexual assault are evaluated. Lastly, two new interventions – chlamydia testing at home for young, low-risk heterosexual persons and an online partner notification website - are evaluated.
Evaluations as described in this thesis are invaluable for STI clinics to make the right evidence-based decisions.